Form D-400x - Amended North Carolina Individual Income Tax Return - 2012
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Amended North Carolina
D-400X
PRINT
CLEAR
Web-Fill
Individual Income Tax Return 2012
12-12
Print in Black or Blue Ink Only.
IMPORTANT: Do not send
North Carolina Department of Revenue
No Pencil or Red Ink.
a photocopy of this form.
For calendar year 2012, or fiscal year beginning
and ending
(MM-DD-YY)
(MM-DD-YY)
Your Social Security Number
Spouse’s Social Security Number
You must enter your
social security number(s)
Your First Name
(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
M.I.
Your Last Name
If a Joint Return, Spouse’s First Name
M.I.
Spouse’s Last Name
Mailing Address
Apartment Number
City
State
Zip Code
Country (If not U.S.)
County
(Enter first five letters)
Deceased Taxpayer Information
Reason for Amending Your Return
(Fill in the circle for all applicable boxes; see instructions)
Original return has been previously audited by the Department
Fill in circle if return is filed and signed by Executor,
Administrator or Court-Appointed Personal Representative.
Federal audit change
Important
Filing Status
Taxpayer
You must complete the entire form
(MM-DD-YY)
Claim of right
including the explanation
If return is for
of changes section on Page 4.
a deceased
Treaties
taxpayer or
Protective claim
deceased
spouse, enter
Spouse
(MM-DD-YY)
Net operating loss (Include copy of your federal form 1045, including Schedules A & B)
date of death.
Tax credits (Attach Form D-400TC)
Other
Were you a resident of N.C. for the entire year of 2012?
Yes
No
Residency
If No, complete Lines 1 through 15. Then go to Page 4 of Form D-400X.
Was your spouse a resident for the entire year?
Status
Fill in residency information and complete Lines 50 through 52.
Yes
No
Filing Status
Same as federal. Fill in one circle only. If your spouse was a nonresident and had no North
Carolina taxable income in 2012, see the Line Instructions for Lines 1 through 5. If you do not
Enter the Number of
indicate your filing status by filling in one of the circles, any refund due will be delayed.
1.
Single
Exemptions claimed
on your federal
2.
Married Filing Jointly
income tax return
Name
(Enter your spouse’s
3.
Married Filing Separately
full name and Social
Security Number)
4.
SSN
Head of Household
5.
Qualifying Widow(er) with Dependent Child
)
(Year spouse died:
Enter Whole U.S. Dollars Only
6. Federal adjusted gross income
(Form 1040, Line 37; Form 1040A, Line 21;
or Form 1040EZ, Line 4; or Form 1040X, Line 1)
6.
(If negative, see the Line instructions)
7. Additions to federal adjusted gross income
7.
(If applicable, complete Lines 33 through 36 on Page 3
and enter amount from Line 36)
8. Add Lines 6 and 7
8.
9. Deductions from federal adjusted gross income
(If applicable, complete Lines 37 through 49 on Page 3
9.
and enter amount from Line 49)
10. Subtract Line 9 from Line 8
10.
11.
N.C. standard deduction
OR
N.C. itemized deductions
11.
ImPORtaNt: Do not enter the amount from your federal return.
(You must fill in appropriate circle. See instructions on Pages 7, 8, and 9)
12.
12.
Subtract Line 11 from Line 10
13.
N.C. personal exemption allowance (See instructions on Page 9)
13.
14.
Subtract Line 13 from Line 12
14.
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